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(Circulation. 2004;109:III-15 – III-19.)
© 2004 American Heart Association, Inc.

Atherosclerosis: Evolving Vascular Biology and Clinical Implications

New Risk Factors for Atherosclerosis and Patient Risk Assessment

Jean-Charles Fruchart, PhD; Melchior C. Nierman, MD; Erik S. G. Stroes, MD, PhD; John J. P. Kastelein, MD, PhD; Patrick Duriez, PhD

From the Département de Recherche sur les Lipoprotéines et l’Athérosclérose (P.D., J.-C.F.), Institut Pasteur de Lille, Inserm U545 et Faculté de Pharmacie, Université du Droit et de la Santé de Lille 2, Lille, France; and the Department of Vascular Medicine (J.J.P.K., M.C.N., E.S.G.S.), Amsterdam Medical Center, Amsterdam, the Netherlands.

Correspondence to Professor Jean-Charles Fruchart, Département de Recherche sur les Lipoprotéines et l’Athérosclérose, Inserm U545-Institut Pasteur, 1 rue du Pr Calmette, BP 245, 59019 Lille, France. E-mail Jean-Charles.Fruchart{at}pasteur-lille.fr

Advances in our understanding of the ways in which the traditional cardiovascular risk factors, including standard lipid (eg, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol) and nonlipid (eg, hypertension) risk factors, interact to initiate atherosclerosis and promote the development of cardiovascular disease have enhanced our ability to assess risk in the individual patient. In addition, the ongoing identification and understanding of so-called novel risk factors may further improve our ability to predict future risk when these are included along with the classic risk factors in assessing the global risk profile. This review briefly summarizes the evidence that some newer risk factors, including impaired fasting glucose, triglycerides and triglyceride-rich lipoprotein remnants, lipoprotein(a), homocysteine, and high-sensitivity C-reactive protein, contribute to an increased risk of coronary and cardiovascular diseases.

Key Words: atherosclerosis • novel risk factors • risk assessment • triglycerides